Aurora St. Luke’s Medical Center

Presentation Notes

Quality Improvement poster presented at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.


Background: Restraints increase a patient’s risk for an adverse event. Advocate Aurora Healthcare System’s goal is to reduce overall restraint use, within a least restrictive, safe, and clinically appropriate environment by protecting each individuals’ patient rights and their overall well-being.

Local problem: Restraint utilization in the cardiovascular intensive care unit (CVICU) has been historically higher than in other units due to caring for a post-operative cardiac surgical patient population. In quarter four of 2021 restraint use was 240 cases representing 39% of overall hospital restraint utilization. In quarter one of 2022 this increased to 359 cases representing 44% of hospital site restraint use.

Method: The plan do study act method was used for this quality improvement project aimed to reduce restraint use in the CVICU. A team consisting of a CNS, quality analyst, and clinical nurses evaluated current clinical practice standards and documentation, restraint data, and surveyed nurses on their perception of restraint use in the cardiac surgery population. Restraint education was provided to all hospital staff, with targeted education for CVICU staff in May 2022. Education focused on addressing restraint alternatives, determining whether the behavior fit the restraint, documentation, and the goal to extubate within 6 hrs.

Results/Conclusions: The nursing perception of restraint use survey in CVICU found that safety is the main reason for restraint usage. Nurses reported feeling “huge risk for early and unplanned extubation”. Restraint utilization for CVICU in quarter two, 2022 consisted of TBD cases, representing TBD% of hospital restraint utilization. And quarter three, 2022 decreased to TBD cases, making up TBD % of hospital total.

Implications for practice: Further work and efforts need to focus on appropriate restraint application based on patient behaviors with the least restrictive restraint that protects the patients’ right to be free from restraints that are not medically necessary.

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